? 11-22 Panzer AMPS 169/169@+2.75/116@+7/ I may have to go in for emergency surgery/ dose for Panzer

I'm bleeding alot may have to go in for emergency surgery tonight. We are @+11.25 AMPS right now. How much should I shoot & have my daughter shoot if I have to go in tonight? I believe he's bouncing right now.

 

He's at 203 @11.5 AMPS. Sorry I am very out of it right now.

 

Can your daughter monitor the cycle and does she know what to do if the BGs drop low?

 

I’m so sorry you’re going through this!

I’m no dosing expert by any means, but based on how 2.5 has been going, I’d feel pretty comfortable shooting that much. Can your daughter get a BG test tonight?

 

No she doesn't know how to test. I was supposed write everything down for her on feeding & she was supposed observe feeding & injection but she hasn't yet. Didn't know that I may have an emergency.

 

I also notice you said he vomited the +2.75 snack this cycle. Has he been ok since?

 

It always happens like this! Did you see my question about the vomit?
Can she be around to give him snacks?

 

No she doesn't know how to do anything she was supposed observe feeding & injecting before my scheduled Surgery on 12-2 but hasn't yet.

 

Spook vomited @ AMPS my other kitty. He's been fine since then though.

 

Ok I’m confused. The SS is Panzers.is that right? Not sure why you are putting information about Spook in Panzers remarks column…

 

Yes if I have to go in she will have to come here & feed them @+6 PMPS that's normally the only feeding they have after PMPS feeding. Then they eat again @ AMPS & again between @+2 &@+3 AMPS they have a snack.

 

Yes it's Panzer's but I put stuff for Spook on there so I can go back & look at it for reference. I have started writing things in my notebook that I keep as well. I can just do that if I need to.

 

I think it would be better to just put things about Panzer in his SS if you don’t mind, otherwise it is too confusing for others when looking at it. We don’t expect to see information about other kitties in an SS.

Panzer looks as if he is doing well and is stable on the current dose but because your daughter can’t test and could be possibly shooting tomorrow without testing, I would reduce the dose to 2.25 units. Or if you think is would be safer for her to draw up 2 units…then go with that. Better to be safe.
The first half of this PMPS cycle will be affected by the previous cycle so I would leave out an extra snack.
Are you happy with that?
I do hope all is Ok with you.

 

Sorry you're going through this, hope everything goes well!

 

Yes that sounds good!

I went ahead & shot 2.5 tonight. The doctor told me to take a second birth control pill tonight & one in the am tomorrow & one in the pm tomorrow. Hopefully it will slow down soon. I really wanted my daughter to be there with me for the surgery but she can't be in 2 places at once. Maybe my son can be with me for the surgery. Hopefully it doesn't come to that!

My daughter has no idea how to even draw the insulin. I know your not supposed to with Lantus but can I prefill a couple of syringes with 2 units just incase? I'm using a pen now & not a vial.

I will make a new post for tonight if I'm here, if I don't make one then you know I had to go in for emergency surgery.

 

I can answer this from a pharmacy tech perspective.

If you swipe the top of the vial with alcohol before you draw up - three swipes with the pad in the same direction, not circles; you want it really clean - and then don’t touch the top while you’re working with it, AND you keep the syringes in the fridge along with the vial - the insulin can stay good for up to 96 hours, or four days, in a syringe. This is what we do in the (human) hospital.

Making sure the top and syringes stay super clean while you’re drawing it up is key to this. You don’t want any bacteria introduced.

But if you can do that, then yes, you can draw some up. I regularly draw up both of a day’s doses each AM, because half the time another family member has to shoot PM. Just warm each syringe up after pulling it from the fridge before giving it to the cat.

 

Okay thank you. I'm going to eat something take this other pill & attempt to go to the store. I've been through 20 pads in 3hrs & a full roll of toilet paper in the past almost 3hrs, so I will pick up some alcohol wipes as well.

 

The little ones in the pharmacy department that they have in the diabetic stuff section work well. Plus they’re individually wrapped so you always know that every time you enter the vial it’s clean.

I feel your pain, and I truly hope the best for you. My uterus and I parted ways back in 2017 for similar problems. Drive very carefully please. I used to get really lightheaded. If anyone else can drive you that would be best.

 

With Lantus it is not recommended that doses are drawn up ahead of time as the insulin can interact with the solution (corrected autocorrect) in the syringe.

 

It’s not generally recommended for consumers to do by the manufacturer, but I can tell you that it’s done institutionally all the time. We even get training on how to do it for the longest safe life of the drug. Also maybe the keeping it in the fridge plays a factor… (I’m guessing you’re talking about the silicon coating on the barrel interior? I think your device typoed you. )

It may not be the ideal to leave it in a syringe that long, but in an emergency especially it is possible, as long as you take enough sterilizing precautions.

Edit: I did just go looking up the sticky with info on prefilled syringes because I was curious. Interesting results from that study… insulin turned turbid (cloudy) after 3 or less days? Wow! Actually it makes me wonder if they use a different form of the lubricant now than they did back in 2003 when the study was done, because I can tell you the ones we pre-make at the hospital look exactly the same when we “expire” them as they do when we first draw them up. Makes the scientist in me curious now…

 

Yes this is why we don’t recommend prefilling Lantus syringes
I corrected the autocorrect in my post above. Thanks for pointing out. The autocorrect drives me mad!

 

Sending prayers.

 

Yikes, how stressful! Hope the pills work and you can avoid emergency surgery! Sending healing vibes

 

Thanks everyone so far so good. The bleeding has slowed down some, it seems the more active I am the less bleeding but I have to sleep sometime. I took the extra pill & some advil as the doctor directed me to & will continue with that & hopefully make it to Dec 2nd. I'm worried about bleeding out during the surgery & having to get a blood transfusion & possibly having to stay longer. The surgery should only take an hour & recovery time is 2-4hrs at the hospital. Then I will have the weekend to recover before I'm back to work. It's times like these that I wish I had a significant other to help with bills emotional support & of course the boys!

I'm writing down detailed instructions for my daughter on how to feed, meaning how much they each get what time & how much water to add to there food. They also go through spouts of needing fortiflora on there food. I think they are sick of fancy feast so I've been giving them a couple of weruva BFF pates & Sheba pate's.I will probably also set up pill pockets in baggies labeled with which pills they are. Unfortunately since Spook is still puking & I don't know which one is puking up a little bit of liquid by the back door almost daily. Otherwise the only pill she would have to give in a pill pocket would be Panzer's zobaline. Since Spook puked though they are still getting 1/4 of a pill of ondansetron 1 time a day. They also have there probiotic every morning mixed in with baby food. They are so complicated & maybe a bit spoiled

 

Thank you

 

Thank you

 

She's needs to get her butt over here so she can draw it up out of the pen!

 

My daughter will be driving me or an ambulance if it becomes an emergency.

 

Thank you

 

I do have to wonder though if it’s still a valid concern. As I said, we prefill Lantus daily at work… expire it after 4 days… and it’s still clear, not turbid, when we throw any unused syringes away. (Honestly I’ve seen forgotten ones a whole week later and they were still clear, though well beyond when our policy would allow usage.) Based on that study, your concern is a valid non-recommendation! I just wonder if it’s old data by this point. That was written almost 20 years ago, the syringes well might have changed. Science and tech and medicine are all changing fields…

That’s just my personal experience, for whatever you find it worth. (Shrug)

 

I would discourage this and we never warm the syringe. In fact, cold needles actually cause less pain when the injection occurs. While this is not something necessary for treating FD, if one is giving subq fluids, it’s recommended to keep the needles in the freezer until they need to be used. I’ve done this for years when administering subq fluids.

The reason manufacturers suggest to not prefill syringes is there is potential, especially with Levemir, for the insulin to adhere to the plastic so the cat might not get the full dose of insulin. As you stated in post 20, the insulin can get cloudy after a couple of days and the efficacy cannot be guaranteed.

There has not be any change to syringes which would preclude the issue from occurring. When members have had to be gone in the past and someone else was shooting, they would mark the syringe with tape to the correct dose.

@Chrispooky12
you do not need alcohol wipes as Skye suggested. There is a big difference between how a hospital administers insulin and how a person at home would. In other words, in a hospital, they could have a lot of different people drawing from the same vial. And I believe you are drawing from a pen so you definitely wouldn’t do it.

And, I will add that cats are not furry humans. If insulin were to stick to a syringe and the dose be less or the insulin compromised, in your situation, there would be no one to monitor that. In a hospital, they would be able to quickly assess if there was an issue. Small changes in efficacy might not affect a human as it would a cat.

 

Gosh that sounds so scary. I hope you’ll be ok and have the surgery when it’s best for you. Take care!

 

Thank you I will just mark an unused syringe for her or fill it will colored water.

 

@Chrispooky12
@Skye & Jackson

I got a head's up about this thread. I work at a major academic medical center. It so happened that our PharmD (this is a person with a doctorate in pharmacy science) was on rounds with us. I asked her about pre-filling syringes with Lantus. Her response was, "Don't do it." The only way that pre-filling a syringe is safe is if it is done under a hood and with sterile protocol being followed. Under those conditions, the insulin may hold for 24 - 48 hours.

The other issue is that while there has been some change in syringe coating technology, the bulk of the change is related to glass syringes. Most of the plastic syringes are still sprayed with a silicon coating. The original coating of a syringe barrel is sprayed-on silicone. However, studies show that extended drug exposure to silicone can cause formation of silicone oil droplets—part of the particle formation count of a syringe—that may interact with proteins and cause aggregation. This can interfere with drug efficacy and cause complications. This is a 2022 article on the topic.

 

@Sienne and Gabby (GA) thank you, I definitely don't want to do any prefilling of syringes. I talked to my daughter on the phone earlier & she is coming over 30mins prior to shot time. So she will can watch me test, draw up the insulin, feed, & shoot him. Thank you so much for this information.

 

@Marje and Gracie
@Sienne and Gabby (GA)

Thank you both for the detailed information. You are right that we do draw up in the hospital in a sterile hood. We do actually give it 96 hours, and it is true that I haven’t seen cloudiness in that time, but I do appreciate up to date data, especially from a medical perspective, and will admit when I may be wrong. You especially have a point about cats maybe being more sensitive to slight changes in a fill of insulin, because their doses are so much smaller. Maybe humans aren’t as potentially affected. I should have thought of that, really, I apologize. The “emergency use” protocol I was referencing for needing to draw up outside of a hood was designed for humans, and also for emergency situations. (Like disaster level, really.) Protocol does require sterile compounding procedures under normal circumstances. I think I was going into crisis mode, upon hearing the issue… in which case sometimes “best practice” gets supplanted by “what works in an emergency”. I was thinking that having insulin pre drawn was better than no insulin at all. I am glad Chris didn’t have to go for emergency surgery… being able to have the time to do what’s best is a good thing. I will never argue that!

Interesting if brief article! Given the possibility of protein aggregation, I can see that Levemir especially would have a problem. I do still personally feel safe pre-filling one Lantus syringe for my own boy for that same evening, but we’re talking only 12 hours in the fridge, and I’ve seen no difference so far.

Although I do still think alcohol wiping makes some difference in chance of bacterial contamination… I want my vial to last as long as it can. I have no idea why that wouldn’t normally be recommended as a matter of general practice, especially for human patients.

As for the warming though, I’m curious - I’ve been letting each dose get to room temperature before giving it because I was told by the vet that the acidity in Lantus stings more when cold. That’s also something I’ve read in documentation designed to give to humans. Have you seen otherwise?

 

Thank you both for your thoughtful replies. The original information about pre-filling syringes is dated and to a degree, it's surprising that the technology hasn't caught up. My hunch is that with the new(ish) insulin pens, the insulin is housed in a glass vial so there's been less impetus to do research that involves plastic syringes. The insulin pens are great for adult humans. The number of children with diabetes is far less and there's likely less incentive to look at the syringe technology for kids and cats!

I think if the situation warrants a disaster mode, you do what you need to do. You may see us be less consistent with our information if, for example, we discussing what to do when the kitty has just been released from the ICU after having been treated for DKA. Getting food and insulin into the cat is critical to keep ketones at bay. Ketones pretty much trumps everything!

I don't have an answer to your question about whether room temp or cold Lantus stings less. We will often suggest that Lantus users with a cat that has acromegaly or insulin auto-antibodies and requires a large dose of insulin switch to Levemir due to how Lantus can sting. I also wonder if this isn't also something that has come up since the pens have been in greater use. The pens are portable and do not need to be kept refrigerated once opened. However, we do suggest keeping them refrigerated since cats typically need a small fraction of the dose that humans need and humans go through a pen in a comparatively very short period of time. Storing your cat's pen in the refrigerator is likely to preserve the insulin for what could be 3 mos. or more. In addition, keeping the pen at a constant temperature preserves the mechanism for dispensing insulin. If you know anyone who is a Lantus user, I'd ask them if it stings more if at room temp or cold. Our cats refuse to give us that information.

 

I read several forums of human diabetics when I was trying to figure out why Biggie was reacting poorly to his injections after he had been fine for the first few weeks and a lot of people did say that cold Lantus stings. I always warm the barrel between my fingers and it seems to help.

 

I give Panzer his insulin straight out of the refrigerator & doesn’t even flinch, he's to busy eating. If only they could talk, it sure would be nice.

 

It does sound like with the advent of pens, all other research kind of went by the wayside! Unfortunate for us, but at least that’s a reason that makes sense for the lack of syringe and temperature info. Although there actually are still people who use Lantus vials too. Just not as many anymore. Vials and syringes are all we use in the hospital, though… and in most other health care settings. It’s interesting that at least a little more study hasn’t been done, or syringe tech updated… I mean, it’s not like syringes aren’t used for half of everything in a hospital!

I agree, it would be very nice if they could let us know things. Things like not feeling great at some point before they’ve had blood sugar in the 300s for months and wind up with DKA….

 

If I’m in a hurry I’ll tuck it under my armpit while I get food and stuff ready. Otherwise just letting the syringe sit at room temp for a little while seems to work… I know you’re not supposed to let it actually heat too much, but body temp is fine, from the things I’ve read for humans.

 

My daughter came over & she watched me test,feed,fill the syringe to the correct line in the syringe, & give Panzer his shot. She took a video of everything as well. She said she would test him if Panzer will let her. I think he will, he got right up in his box in front of her & her boyfriends mom & let me test him. I think he liked the extra attention. She was a little confused about what line to take it to but she just came back & I had her use my practice syringe in an old vial of prozinc that I haven't disposed of yet & she pulled the right amount down 3xs I showed her where 2 units were & 2.5 units which is his dose as of right now. I told her if she's going to stick around & monitor & test him she can give his full dose otherwise she will give the reduced dose. I feel like a weight has been lifted off of me now! Thank God for my daughter I don't know what I would do without her.

On another note I'm just barely spotting now, so I'm hoping what the doctor told me to do is working & I make it to December 2nd & everything goes good!

 

Yay for helpful family members, and YAY for medication working for you! Good luck with surgery and everything health related! I can assure you, you will NOT miss the monthly misery! Lol!

 

No apology necessary. You were doing what you could to offer help in an emergency and, it is true, sometimes in emergencies we have to do what we have to do and hope we can limit the a,pint of time we have to do something we normally wouldn’t.

Like Sienne, I am primarily aware of Lantus stinging at higher doses and I don’t know if letting it warm to room temp would reduce that but, for those higher doses, I rather doubt it.

Chris…I’m glad your daughter took some of the burden from you and you are doing a bit better. I hope all goes well for you until and during your surgery.

 

Hi Christina just catching up, I'm glad you didn't have to have the emergency surgery. It's great that your daughter can now give insulin and test him when ever you need her help. Just looked at Panzer's SS for today (11-27). a nice start. I just noticed you increased the dose, good luck with that
Take it easy Christina and keep us updated ok
@Chrispooky12

 

Thanks Diane, yes I am very lucky to have such a caring daughter.

 

I will make a post in a couple of days for a surgery dose. I did increase Panzer to 2.75, it had been well past 7 cycles since he was bouncing. Unfortunately I'm moving his shot time as well because I have to be at the surgery center at the same time that I normally do his shot. His numbers have been high for Panzer, hopefully once he's moved to an hour earlier they will get better. He will be at an hour early on Wednesday @ AMPS shot, 2 days before my surgery of course he will probably give me some low ball numbers probably the day of my surgery. Hopefully I will be okay to test once I get home from the hospital. I am a test-o-holic & I don’t think I can handle not knowing what his #s are

 

Christina. Are you okay? Let me know how you are doing. I'm very concerned. How are Panzer and Spook. I just thought I'd check in on the forum and now I see this! When are you having surgery?

 

Hi @Suzanne & Darcy I am doing okay still having some bleeding despite taking 2 birth control pills a day & the maximum amount of ibuprofen, but it's not heavy like it was. Panzer's #s are a little high which concerns me. They both have there moments of not wanting to eat. I've been trying a couple of different foods Sheba pate's & weruva that they've had before. They both seemed to like the Sheba until today, Spook refused to eat @AMPS this morning & Panzer had to have fortiflora on his Sheba @AMPS, I think he just started acting up because he saw Spook was. He also had to have fortiflora on his PMPS feeding as well. I think they are both sick of fancy feast but they both don't seem to like the same foods sometimes. Panzer really likes the fancy feast naturals, but Spook hates it. I bought a couple of cans of tiki Kat & some pouches as well. I'm waiting until after my surgery to try those though. My surgery is Friday December 2nd, I have to be there at 6am & they said I should be home by noon. The boys normally have a snack between +2 & +3 AMPS but I will still be at the hospital & my daughter will be there with me. She's going to stay with me Friday after I get home as long as I need her to. I have a client who had the same surgery & she said she was tired & a little bit of stomach cramping but other than that she was fine. I'm hoping that's how it will go for me as well.

 

I’m glad you are doing a bit better. I will be thinking about you and praying everything will go smoothly. You will have time to see this week how he’s doing on the 2.75 dose; I hope he will get down into better numbers.

 

Was just thinking about you. Be careful about the Ibuprofen because it definitely thins the blood and increases the risk of bleeding. In fact, red wine, fish oil, ibuprofen (Motrin, Advil), aspirin, Naproxen (Aleve) and quite a few herbal supplements do thin the blood and should be avoided before surgical procedures. Acetaminophen (Tylenol) does not thin the blood so it’s okay to use as long as your doctor doesn’t have any reason why you cannot take it. I would see about stopping the blood thinning meds at least 48 hours prior to any surgery. Check with your doc.

 

My family doctor told me the same thing to stop the ibuprofen a week before the surgery & take Tylenol, also the brochure that I got from the surgery center has that listed on there to stop taking 7 days before my surgery. When I was on the phone with the surgeon on what to do about stopping the bleeding, he said to max my dosage out on the ibuprofen & take it all the way up until the surgery. I said something to him about my family doctor & the brochure saying to stop the ibuprofen & he said that's just asprin. I'm not sure if I can take Tylenol. My Mom & both of my sisters had allergic reactions to it, they all broke out with hives. I think tomorrow will just be my last day to take it & see what happens. My biggest concern is the general anthesia. After my Mom had a stroke having her gallbladder taken out while under anthesia I'm scared! I've had one surgery since she passed away & that was emergency surgery on my leg from a lawn mower accident. I have so many of her bad traits it's not even funny. At the beginning of November I was having vision problems dizziness & numbness & tingling in my hands & feet twice a few days apart. All symptoms of a stroke, my Mom had several mini stokes over the years prior to the big one. I told my doctor so she did bloodwork at my pap smear appointment. Everything came back fine & no episode's since then.

 

Hey Christina, I know you must be very nervous and scared, You will be fine ♥
I'm saying prayers for you every night ! You will be ok!
I'm glad all your blood work came back good . Try and stay calm

 

Thank you Diane ❤ that means alot to me

 

Christina, I am glad you are aware of the problem with the ibuprofen. I don’t agree with your surgeon that it’s just aspirin. That seems a casual attitude to take. I will pray for you to be okay through this. I promise. It will be Friday, right?

 

Sending good vibes your way! It's normal to be nervous, try to remember to breathe... we are all rooting for you

 

Yes it's Friday thank you Suzanne ❤

 

Thank you

 

I didn't get to test Panzer today due to my car breaking down. I just paid $175 of my rent $ just to get it towed back to my hometown, not sure how much it's going to cost to fix it. I was working 25miles from home! Why couldn't this have happened tomorrow or the next day, I work in my hometown both days! Luckily Cam was able to come & feed the boys. I've got my daughter's back up car so I guess I have something to be grateful for!

 

I'm sorry about your car, that really sucks ,when it rains it pours right!
Glad you have your daughter's car if you need it. Hoping it's something minor that has to be fixed

 

Oh, Christina. I'm sorry about your car. And the towing bill! I have a roadside assistance plan on our insurance and it pays for towing... can't tell you how many times I've used that! I find car problems to be really distressing (lack of car... expensive repairs!) But you have a back up car so I'm really happy to hear that. You have a great daughter.

 

I called my car insurance company & they said to bring them the tow bill & they will reimburse it to me. My car insurance bill was due yesterday though so I will have to give them $130 back. I was planning on paying it late so I could get my rent paid but not going to be able to do that now. A friend of mine is going to meet me up at the automotive place where it's at & see if he can fix it. I doubt they will let him fix it on there lot if he can even fix it. My daughter is a God send, I really don't know what I would do without her. I wish my son would help me out more but he's to busy with work!

 

On the bright side Panzer's #s are awesome ❤

 

He is doing better with the increase. I'm glad! He says... Mom, don't worry, I'm going to be a good boy for you!

 

I don't know if it's because I changed sides that I'm shooting him or if he's just doing well with it. I don't feel a Lantus pocket on that side like I did on the side I'm shooting on now but it's long gone so we're switching sides for now.